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The Usefulness of Magnetic Resonance Cholangio-Pancreatography in the Diagnosis of Choledochal Cyst.

Yong Hoon KIM ; Soon Ok CHOI ; Woo Hyun PARK ; Hee Jung LEE

Journal of the Korean Surgical Society.2003;64(5):402-407.

PURPOSE: Choledochal cysts are cystic or diffuse dilatation of any portion of the biliary tree. An anomalous pancreaticobiliary ductal union (APBDU) is one of the commonly accepted causes of a cholodochal cyst. The ability of MRCP to demonstrate an APBDU has not been established in children and appears to have limited value in demonstrating an associated APBDU. We investigate the usefulness, and application, of MRCP in delineating the cyst type and an APBDU in patients with choledochal cysts, and compared it with operative cholangiography. METHODS: Ten children with choledochal cyst, who had both MRCP and cholangiography, as preoperative diagnostic modalities, at the Division of Pediatric Surgery, Keimyung University, Dongsan Medical Center, between March 1999 and August 2002, were selected for this study. We analyzed and compared their MRCP images with those of the intraoperative cholangiographies, with regard to the type of cyst, size and association of an APBDU. RESULTS: The types of the choledochal cyst, based on the MRCP, were two Ia, three Ic, and five IVa, whereas those based on the operative cholangiographies were one Ic and nine IVa. A common channel was demonstrated by MRCP and operative cholangiography in four (40%) and six (60%) of the ten patients, respectively. Each diagnostic modality correlated with the size (Pearson correlation, P<0.01) and the length of the cyst, but an APBDU on both modalities did not reach statistical significance, even though the common channel was not identified in a large cyst on MRCP. CONCLUSION: MRCP is a noninvasive and safe diagnostic modality for the delineation an APBDU in children with choledochal cysts. However, it has limited value for demonstrating an APBDU in children with a large cyst due to overlapping with the pancreaticobiliary ductal system. Operative cholangiography seems to be more valuable than MRCP in patients with large choledochal cysts.
Biliary Tract ; Child ; Cholangiography ; Choledochal Cyst* ; Diagnosis* ; Dilatation ; Humans

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The Safety of a Laparoscopic Cholecystectomy in Acute Cholecystitis in High Risk Patients Older than Sixty.

Nam Joon YI ; Ho Seong HAN ; Young Woo KIM ; Seog Ki MIN ; Yong Man CHOI

Journal of the Korean Surgical Society.2003;64(5):396-401.

PURPOSE: To evaluate the safety of a laparoscopic cholecystectomy in acute, or complicated, cholecystitis in patients older than sixty. METHODS: A prospective study was performed, at the Ewha Womans University Mokdong Hospital, on a series of elderly patients (>60 years; n=137) who had undergone a laparoscopic cholecystectomy due to acute, or complicated, cholecystitis between March 1997 and December 2001. We divided the patients into 3 groups; ASA 1 (n=33, 24.1%), ASA 2 (n=79, 57.7%) and ASA 3 (n=25, 18.3%), according to their ASA (American Society of Anesthesiologist) classification. No patient was categorized as either ASA 4, 5 or 6. RESULTS: The mean age of the ASA 3 patients was 71.9+/-6.9 years, which was older than the 65.7+/-6.0 years of the ASA 1 patients (P<0.05). The preoperative hospital stay for the ASA 3 patients was 8.8+/-5.6 days, compared to 5.6+/-3.7 days for the ASA 1 patients (P<0.05). The incidences of complicated cholecystitis were lower in the ASA 1 (n=8, 24.2%) than in both the ASA 2 (n=40, 50.6%) and 3 patients (n=12, 66.7%) (P<0.05). The mean operating times for the ASA 2 and 3 patients were longer, at 111.0+/-58.2 and 114.0+/-62.7 minutes, retrospectively, than the 85.0+/-33.1 minutes for the ASA 1 patients (P<0.05). Drain insertions were more frequently performed in the ASA 2 (n=33, 44.4%) and 3 (n=15, 60.0%) than in the ASA 1 patients (n=10, 30.3%) (P<0.05). Postoperative morbidity was more frequent in the ASA 3 (n=5, 20.0%) than ASA 1 (n=3, 9.1%) patients. However, in terms of the postoperative recovery parameters (time to diet, hospital stay), there were no difference between the three groups (P>0.05). One death, due to acute myocardial infarction, occurred in one of the ASA 3 patients. CONCLUSION: A laparoscopic cholecystectomy in acute, or complicated, cholecystitis could be an option in elderly-high risk patients.
Aged ; Cholecystectomy, Laparoscopic* ; Cholecystitis ; Cholecystitis, Acute* ; Classification ; Diet ; Female ; Humans ; Incidence ; Length of Stay ; Myocardial Infarction ; Prospective Studies ; Retrospective Studies

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Totally Laparoscopic Anatomic Liver Resection.

Seog Ki MIN ; Ho Seong HAN ; Hyeon Kook LEE ; Shen JIE ; Kwon YU ; Nam Joon YI ; Yong Man CHOI

Journal of the Korean Surgical Society.2003;64(5):390-395.

PURPOSE: There have been several recent reports of laparoscopy-assisted procedure for limited, or a laparoscopic, resections of small lesion of the liver. However, there are few reports on total laparoscopic surgery in anatomic resections, which is due to high level of skill required for the procedure and the risk of an air embolism. The aim of this study was to determine the safety of total laparoscopic surgery in anatomic liver resections during our early experiences. METHODS: The 6 patients included in this study were all treated with a totally laparoscopic anatomic resection of the liver at Ewha Womans University, Mokdong Hospital between September 2002 and January 2003. All 6 cases were diagnosed with an intrahepatic duct (IHD) stone, with stricture and/or common bile duct (CBD) stones. Of these 6 cases, 2 underwent a totally laparoscopic left lateral segmentectomy of the liver. In the remaining 4 cases, totally laparoscopic left lobectomies and CBD explorations, with T-tube insertion, were performed. In all cases, 4 trocars were used. During the operation, the intraperitoneal pressure of the pneumoperitoneum was maintained between 8 and 12 mmHg using CO2. The instruments used included Ligasure(R), Autosonix(R), 0 degrees and 30 degrees camera, fan retractor, Endo(vascular)- GIA 30 , and a large LapBag(R). All cases were managed in the supine position, with 15 degrees of left tilting. The specimen were extracted through a 4 to 5 cm extension of the upper trocar site. The T-tube exited through a 12mm site in the right upper port, and a drain was inserted into the sub-hepatic area. RESULTS: The patients comprised of 5 women and a man, with a mean age of 50.2 years old. The mean operative time was 469.2 (+/-141.4) minutes. In one case, 2 pints of packed red blood cells had to be transfused during the operation. The mean time to diet was 3.3 days. The mean postoperaitve hospital stay was 11.7 days. There was no conversion to open surgery, morbidity or mortality. The mean extensional incision size for the extraction of the specimen was 4.3 cm. CONCLUSION: In the anatomic resection of the liver, especially for benign liver disease, a total laparoscopic resection could be another relatively safe option for selected cases.
Common Bile Duct ; Constriction, Pathologic ; Conversion to Open Surgery ; Diet ; Embolism, Air ; Erythrocytes ; Female ; Humans ; Laparoscopy ; Length of Stay ; Liver Diseases ; Liver* ; Mastectomy, Segmental ; Mortality ; Operative Time ; Pneumoperitoneum ; Supine Position ; Surgical Instruments

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Outcome of Potentially Curative Gastrectomy in Patients with Stage IV Stomach Cancer: Based on the 5th Edition of AJCC/UICC Classification (1997).

In Mok JUNG ; Jun Suk SUH ; Young Chul KIM ; Seung Chul HEO ; Young Joon AHN ; Jung Kee CHUNG

Journal of the Korean Surgical Society.2003;64(5):383-389.

PURPOSE: The prognosis after potentially curative resection for stage IV gastric cancer, according to the 5th edition of AJCC/UICC classification, is poorly understood. The aim of this study was to evaluate the feasibility of the curative resection in patients with stage IV gastric cancer, which were considered potentially curable cases. METHODS: From November 1991 to June 1996, 91 patients were confirmed as having stage IV gastric cancer at Seoul Boramae Municipal Hospital. Of these 91 patients, 30 who were potentially curative resected including at least D2 type lymph node dissections were reviewed retrospectively. The average numbers of totally dissected and positive lymph nodes were 43.0 (range: 26~74) and 23.1 (range: 2~47), respectively. RESULTS: The overall 1-, 2-, and 5-year survival rates of patients were 60.0%, 36.7%, 13.3%, respectively. In comparison with stage IIIb (N=20), no significant difference in survival rate was observed (P=0.1178). In univariate analysis, we found that the presence of a recurrence (P=0.0121) and a P (positive lymph nodes)/R (total dissected lymph nodes) >0.6 were correlated with poor survival rates. Long- survivors (N=12, more than 24 months postoperatively) had a tendency to be younger, less recurrent (P=0.017) and less involvement of histological perineural invasion (P=0.028). CONCLUSION: The results of the present study indicate that stage IV patients without distant metastasis may indeed be cured by potentially curative surgery.
Classification* ; Gastrectomy* ; Hospitals, Municipal ; Humans ; Lymph Node Excision ; Lymph Nodes ; Neoplasm Metastasis ; Prognosis ; Recurrence ; Retrospective Studies ; Seoul ; Stomach Neoplasms* ; Stomach* ; Survival Rate ; Survivors

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Expression of Cyclooxygenase-2 in Well Differentiated Thyroid Carcinoma.

Sang Eok LEE ; Hyo Yung YUN

Journal of the Korean Surgical Society.2003;64(5):377-382.

PURPOSE: Several reports have suggested that the expressing of COX-2 is related to carcinogenesis and the prognosis of cancer. The aim of this study was to discover the relationship between the prognostic factors of a differentiated thyroid carcinoma (DTC) and the rate of COX-2 expression. METHODS: We performed immunohistochemical staining on well conditioned thyroid cancer paraffin specimens obtained from the patients that had undergone a thyroidectomy at the Department of Surgery, Chungbuk National University Hospital during 1994. The specimens were composed of papillary carcinomas (n=23), follicular carcinomas (n=9) and follicular adenomas (n=4). We analyzed the expressions of COX-2 in relation to age, distant metastasis, invasion to extrathyroidal tissue, mass size and risk group. A statistical analysis was performed using the Chi-square, Fishers Exact, and Mantel- Haenszel Chi-Square tests on the PC SAS system. RESULTS: COX-2 was expressed in 82% of the papillary carcinomas (19/23), 33% of the follicular carcinomas (3/9) and none of the follicular adenomas (0/4). There were no significant differences between the expression of COX-2 in all the items compared (P-value>0.05): i.e. age, distant metastasis, invasion to extrathyroidal tissues, mass size or risk group. CONCLUSION: COX-2 was expressed in 82, and 33% of the papillary and follicular carcinomas, respectively. The papillary carcinomas had a higher rate of expression than the follicular carcinomas, but this was not significantly correlated with the clinical and prognostic parameters. These results suggested that COX-2 might not be a prognostic factor in DTC.
Adenoma ; Carcinogenesis ; Carcinoma, Papillary ; Chungcheongbuk-do ; Cyclooxygenase 2* ; Humans ; Neoplasm Metastasis ; Paraffin ; Prognosis ; Thyroid Gland* ; Thyroid Neoplasms* ; Thyroidectomy

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Effect of Mycophenolic Acid and Rapamycin on the Proliferation of Glomerular Mesangial Cell of Rat.

Myoung Soo KIM ; Jehyun PARK ; Jin Soo KIM ; Hunjoo HA ; Hae Jin KIM ; Kyu Ha HUH ; Jang Il MOON ; Jiyeon SEO ; Yu Seun KIM ; Kiil PARK

Journal of the Korean Surgical Society.2003;64(5):372-376.

PURPOSE: Excess proliferation of mesenchymal cells such as vascular smooth muscle cells and glomerular mesangial cells, cause transplant vascular sclerosis and glomerulosclerosis, which are typical pathological lesions of chronic allograft dysfunction. Mycophenoic acid (MPA) and rapamycin (RPM) were recently reported to have strong anti-proliferative potentials toward vascular smooth muscle cells. However, the potential effects of these drugs, either alone or in combination, on glomerular mesangial cells, remain to be reported. METHODS: Primary cultured mesangial cells, from Sprague-Dawley rats, were isolated, and stimulated with 10ng/ml of PDGF. The test drugs MPA and RPM were administered at various concentrations, either alone or in combination, 15 minutes before the addition of the PDGF. The cell proliferation was assessed by [3H]-thymidine incorporation. RESULTS: The PDGF effectively stimulated the proliferation of the mesangial cells. The MPA inhibited the proliferation in a dose-dependent manner. In comparison to the stimulated control, the MPA (above 500 nM) showed a significant inhibitory effect. The IC50 of the MPA, against PDGF-stimulated mesangial cell proliferation, was between 500 nM and 1microM. The RPM, at 10 nM, showed a significant inhibitory effect. In a linear regression analysis, the RPM was supposed to suppress the mesangial proliferation in a dose-dependent manner (P<0.05). The pattern of inhibition for the MPA and RPM combination was very similar to that of either the MPA or the RPM alone. Both the MPA and RPM were shown to independently suppress the mesangial proliferation from a multiple regression analysis (R2=0.415, P<0.001). CONCLUSION: We demonstrated that MPA and RPM significantly inhibited the proliferation of glomerular mesangial cells, and that these effects were well maintained when used in combination. Our data indicate that both MPA and RPM have unique potentials in preventing the development of transplant mesangial proliferation in renal transplant recipients.
Allografts ; Animals ; Cell Proliferation ; Inhibitory Concentration 50 ; Linear Models ; Mesangial Cells* ; Muscle, Smooth, Vascular ; Mycophenolic Acid* ; Rats* ; Rats, Sprague-Dawley ; Sclerosis ; Sirolimus* ; Transplantation

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Expression of Inducible Nitric Oxide Synthase (iNOS) in the Epithelial Cells of the Distended Bile Duct by the Bile Ductal Ligation.

Sang Su PARK ; Guang Bi JIN ; Jin Woo PARK ; Lee Chan JANG ; Ro Hyen SUNG ; Jae Woon CHOI

Journal of the Korean Surgical Society.2003;64(5):365-371.

PURPOSE: Recent studies in an obstructive jaundice rat model showed that the bile duct epithelium is also very important in the bile duct dilatation besides the increased luminal pressure. This study evaluated the role of iNOS in the bile duct epithelium in a rat obstructive jaundice model. METHODS: Bile duct ligations were performed in male Sprague-Dawley rats. The bile ducts were harvested on seven consecutive days. Immunohistochemical staining in the bile duct was performed using anti-iNOS polyclonal antibodies. Aminoguanidine (an iNOS antagonist) was injected intraperitoneally after bile duct ligation (0, 100, and 200 mg/kg/day, n=6 in each group). One week after surgery, the diameter of bile duct was measured and bile was collected for NO analysis by 280NOA (Silvers). RESULTS: The iNOS expression level was increased in the dilated ductal epithelium after the bile duct ligation but not in the normal epithelium. Aminoguanidine decreased the mean diameter of the bile duct after the bile duct ligation: 11/-2.3 mm in the duct ligation only group; 7.5+/-0.75 mm in the 100 mg/kg/day aminoguanidine; 6+/-0.82 mm in the 200 mg/kg/day of aminoguanidine group (mean+/-SE, P<0.05). The NO concentration in the bile was decreased by aminoguanidine: 16+/-4.2 mM in the sham operation group; 40+/-4.5 mM in duct ligation only group; 34+/-6.4 mM in the 100 mg/kg/day of aminoguanidine group; 11+/-1.2 mM in the 200 mg/kg/day of aminoguanidine group (mean+/-SE). CONCLUSION: Bile duct ligation induced iNOS expression in the dilated bile duct epithelium and the iNOS antagonist partially inhibited bile duct dilatation. iNOS induction in the epithelium is partly responsible for the dilatation of the bile duct after duct ligation.
Animals ; Antibodies ; Bile Ducts* ; Bile* ; Dilatation ; Epithelial Cells* ; Epithelium ; Humans ; Jaundice, Obstructive ; Ligation* ; Male ; Models, Animal ; Nitric Oxide Synthase Type II* ; Phenobarbital ; Rats ; Rats, Sprague-Dawley

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A Right Gastroepiploic Artery Aneurysm Treated by Surgical Excision.

Hyangkyoung KIM ; Yong Pil CHO ; Ki Myung MOON ; Sang Joon PARK ; Tae Won KWON

Journal of the Korean Surgical Society.2010;78(6):423-425. doi:10.4174/jkss.2010.78.6.423

A 65-year-old male patient was referred to our hospital for postprandial abdominal pain. Computed tomography and angiography revealed 2 aneurysms of the right gastroepiploic artery, which were measured 0.8x1.3 cm and 1.9x3.4 cm. Excision of 2 saccular and fusiform aneurysms by laparotomy was performed. His hospital course was uneventful and symptoms disappeared after surgery. A gastroepiploic artery aneurysm can cause recurrent abdominal pain and surgical resection is warranted in symptomatic aneurysms.
Abdominal Pain ; Aged ; Aneurysm ; Angiography ; Gastroepiploic Artery ; Humans ; Laparotomy ; Male

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A case of ileal anisakiasis.

Jong Tae SHIN ; Se Jeong OH ; Seung Man PARK ; Young Ha KIM ; Yang Keun PARK ; Yeong Jin CHOI ; Ahn Hee LEE

Journal of the Korean Surgical Society.1992;43(1):152-156.

No abstract available.
Anisakiasis*

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A case of cecal perforation by the stercoral ulcer.

Ghap Joong JUNG ; Jin Sook JEONG ; Hong Jo CHOI ; Young Hoon KIM ; Se Heon CHO ; Sang Soon KIM

Journal of the Korean Surgical Society.1992;43(1):146-151.

No abstract available.
Ulcer*

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